Dysmorphophobia 

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 9, 2012
 

Background

Dysmorphophobia has been described for more than a century.[1] This psychiatric condition, also termed body dysmorphic disorder (BDD),[2] is marked by a fixation on an imaginary flaw in the physical appearance. In cases in which a minor defect truly exists, the individual with body dysmorphic disorder exhibits an inordinate amount of anguish. Body dysmorphic disorder often is encountered in dermatologic and cosmetic surgery settings.[3] This disorder traditionally has been labeled dysmorphic syndrome. Dysmorphophobic symptoms in a dermatologic setting have been termed dermatological hypochondriasis, and in individuals without apparent cutaneous lesions, the condition is termed dermatologic nondisease.[4]

Body dysmorphic disorder results in significant suffering, occupational dysfunction, and/or social malaise. Individuals with body dysmorphic disorder have variable degrees of awareness concerning the psychiatric nature of the illness. Many people continue to agonize about an imagined defect although they are cognizant that their concerns are excessive. Other people with dysmorphophobia are regarded as delusional and have no insight into their unusual behavioral tendencies.[5]

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Pathophysiology

Multidimensional Body-Self Relations Questionnaire results showed body dysmorphic disorder participants differed from population norms in a number of important aspects of body image.[6] Interpersonal concerns about rejection based on appearance should be included in investigations of excessive body image concerns.[7]

Dysmorphophobia may have a genetic component.[8] A twin study from the St Thomas UK twin registry suggested body dysmorphic disorder may be a heritable trait, with nonshared environmental factors also playing a significant role in its causation.

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Epidemiology

Frequency

United States

As much as 1% of the population may have dysmorphophobia.[9] One study demonstrated that the prevalence of body dysmorphic disorder appears to be significantly higher among people receiving dermatologic care. Of people receiving dermatologic care, 11.9% were diagnosed with this condition.[10]

International

BDD is a relatively common disorder among individuals seeking aesthetic surgery in Iran, being seen in about a quarter of those seeking rhinoplasty.[11]

In São Paulo, Brazil the prevalence of BDD in dermatologic patients was evaluated in a sample of 150 patients in a cosmetic group, 150 patients in a general dermatology group, and 50 control subjects.[12] The prevalence in the cosmetic group was 14%, compared with 6.7% for the general group and 2% for the control group.

Mortality/Morbidity

People with dysmorphophobia frequently develop major depressive episodes and are at risk for suicide.[13] They also may exhibit violent behavior toward their treatment providers.

In many cases, individuals with body dysmorphic disorder experience drastic social and occupational dysfunctions that may progress to the point of social isolation. Embarrassment and fear of being scrutinized or mocked cause these individuals to avoid social situations and intimate relationships. Often victims of poor self-image, these individuals do not demonstrate sufficient social skills and frequently are single or divorced. People with dysmorphophobia may believe firmly that a marked change in their perceived body defect is a prerequisite to their happiness and well-being.

Sex

The male-to-female ratio for dysmorphophobia appears to be equal. Males and females tend to focus on different types of perceived defects.[14, 15]

Age

The onset of dysmorphophobia usually occurs in the teenage years; however, average age in people receiving dermatologic care is 33.7 years.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Wanda M Patterson, MD  Department of Dermatology, UMDNJ-New Jersey Medical School

Wanda M Patterson, MD is a member of the following medical societies: Sigma Xi

Disclosure: Nothing to disclose.

O Joseph Bienvenu III, MD, PhD  Assistant Professor, Department of Psychiatry, Johns Hopkins University School of Medicine

O Joseph Bienvenu III, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

M Peter Chodynicki, MD  Staff Physician, Department of Psychiatry, Johns Hopkins University School of Medicine

M Peter Chodynicki, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

Camila K Janniger, MD  Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

James J Nordlund, MD  Professor Emeritus, Department of Dermatology, University of Cincinnati College of Medicine

James J Nordlund, MD is a member of the following medical societies: American Academy of Dermatology, Sigma Xi, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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